Hamstring pain and full extension problem, how are they related?

[adi84_g]

Hy,

I'm in the 20th week post ACL surgery, hamstring graft and I'm still experiencing extension problems.
I've exercised extension since day 1, passive and active too, but haven't got it right yet.During the whole time I had pain the back of the knee when extending.
After a few stretches I have full extension(so I think) but it doesn't last, after aprox 15 min in flexed possition full extension dissapeares.

After 10 weeks I starded to feel  a new pain in the back of my knee, external side, biceps femoris I think.
Usualy this pain comes and goes but sometimes it last for a long period and only painkillers and rest help.
It first appeared after strait leg raises.Sometimes I can barely walk due to the sharp pain that goes down to the foot and toe.

Always after an hour of driving I barely can stand up, so the pain is also there when going from flexed position to extended.

Is this pain related to the knee extension problem?Are they interconected?Do the hamstring muscles limit my extension?or my lack of extension generated the hamstring pain?

[Kaputt_Knee]

When is your next appointment with your OS? If you keep a log of when this occurs and then show them, especially if the pain incidents increase in frequency and pain level.

I had a similar problem after an ACL reconstruction done in 2006. My surgeon ignored the problem and blamed me for not working hard enough on the extension. When I finally got to see another surgeon he diagnosed a postero-lateranl corner injury as well as a misplaced graft. Eventually I had to have a revision, during which it was discovered that my first surgeon had missed a fracture of the fibula head where it inserts into the knee joint/capsule. He had also missed a complete rupture of the lateral collateral ligament and placed his graft too far forward and way too straight. It took over 6 hours on the operating table to sort out the mess.

PLC injuries are often missed by surgeons. Read up on them and see whether there is a possibility that you may have something going on back there as well which is influencing your recovery.

Good luck

Sue 

[adi84_g]

Thx a lot Sue.Today I'm heading to see my OS.

Will look into PLC injuries, but I don't know if this is the case.
My acl has been torn 8 years before surgery and didn't have instability or pain issues.Acl rupture was discovered during exam of another problem, loose cartilage in the knee.

Best regards,
Adi.

[adi84_g]

Sue, could the PLC injury occur after the surgery due tu rehab exercises?The pain is more frequent and more intense.

Anyways due to this rehab exercises haven't been made continously.

[Kaputt_Knee]

I have no idea but I doubt it unless you did something traumatic. That area is a pretty tough one in general and fairly well protected if the joint is stable.

Talk to your OS about it and then monitor the pain in terms of frequency, scale and when it occurs (i.e is there are particular movement/exercise that sets it off).

Good luck

[cbrmedic]

yes, tight hamstrings can prevent  you from achieving full extensions. Im not sure if it just tight hamstrings but if it is, I had the same problems with my extension during my ACLR, even thought AF was my major reason for not achieving full extensions but my hamstrings were so tight everytime i made progress it will limit my extensions. Try to get your hamstrings loosen up by stretching and using heat. I usually stretch my hamstrings for no more than 30secs for 6x, 3 times a day. One exercise that work well for me was the hang prone with ankle weights. Lie face down on a table or bed with the leg hanging off the edge  and let your leg sag down, while doing this have your PT, family member or whomever massage your hamstrings during this exercise.

[adi84_g]

One exercise that work well for me was the hang prone with ankle weights. Lie face down on a table or bed with the leg hanging off the edge  and let your leg sag down, while doing this have your PT, family member or whomever massage your hamstrings during this exercise.

Thx cbrmedic.

For how long should I stay in this position?After 10 min.it gets painfull.
Have you solved your problem?

Monday I went to see my OS.
He said that my hammstrings are very tight and it is due to the hammstring graft + weather change (cold weather front) + my weak quads+lack of extension
He also said that until I have these extension problems when not warmed up I will keep having the pain.I must achive permanent extension.
He prescribed antiinflamatory meds and told me to work intensively my quads.

I'm batter now and doing a lot of quad sets, couldn't do them well before because of the pain.
The meds help a lot.Will have to work a lot while sedated.

[cbrmedic]

yes my problem is already solved, my hamstrings were really tight because i would walk with a limp and made my hamstrings contract. 10min should be fine and then rest and do another 2x for 2 or 3 times a day. Try using a heat pack on the hamstrings for about 5-10 mins, then after there warm up stretch them out for 6x, no more than 30sec a stretch. Make sure you dont force the stretch, you dont want any pain.  And it also best to stretch after all your PT exercises due to all muscle contraction, plus all your muscle is already warm and less tense. you can check out the athrofibrosis section, i post all my PT exericse i did for extensions.

[adi84_g]

Thx a lot, will do that.

I don't limp when I walk but I guess  it's due to the many hours of driving that I do.

[adi84_g]

cbrmedic How much time did it take for you to achive full extension and solve the hammstring pain?

[cbrmedic]

For me, i didnt really have any hamstrings pain, my hamstrings were just tight and tense. I was pretty flexible  before all my injury, so it wasnt hard to get my muscle loose and less tense. I did alot of stretching, use a foam roller and sports massage. it took be about good 2 weeks to get full extension on my first ACLR, on my 2nd ACLR i couldnt get full extension due to scar tissue but after my LOA surgery it took me about 3 weeks. Everyone body reacts and heal different, some may get full ROM quick, some may get it within months. What really works for me was that i had someone push down my knee and have them hold it for a 1min or 2, for 5 times but this is really painful, some PT doesnt even want to do this because of how painful it is.

[adi84_g]

My pain comes from the hammstring beeing very tight.

Had OATs surgery at the other knee and also had problems with gaining full extension but was easier than now.It took me almost 3 months to have it right.Looks like my body reacts very bad in terms of extension of the knee, flexion is good tough.

Thx for advice, will let you know when I improve.I've been working since Tuesday intensely on my extension but very little gain.

[adi84_g]

So after 5 hard working and very painfull days wich included:

-stretches, hang prones with weights, assisted push downs of the knee, and so on;
-a lot of quad sets;
-everyday 500 m swim;
-static bike;

I achived the following:
1.Slightly batter warm extension;
2.Balanced my walk (before I tended to move more weight on the other side of my body);
3.Walk without pain, without a limp (painkillers also help);
4.More powefull quads.

What I haven't achieved is batter cold extension and loosening those very very tight hammstrings.

I'm beginning to feel frustrated here, wasn't expecting to solve my problem so soon but wanted to see at least a little bit of gain.

Would sauna help?Or warm baths in thermal wather?
Or am I expecting results too soon?

[adi84_g]

Update.

Managed to hurt my hamstrings twice yesterday.
After 500 m swim I could barely walk to the car.Pain reduced when I woke up this morning but the knee is swollen, no fluid tough.
Will intrerupt trainning a few days and stick to the stretches only.

Does anyone have this experiece?Is it possible to achive full extension after 5 months from ACL surgery?
When knee is warm and stretched I have full extension but otherwise I lack between 3 and 5 degrees.

[cbrmedic]

relieving tight hamstrings can take sometime, pending how tense and stiff your muscle is, sometimes stretching wont be enough. Sometimes you will need direct pressure and massage. Try a foam roller, there pretty cheap, around $20(US), you can find it at any sporting goods store, even walmarts has them. I would start on my IT band, then onto my hamstrings, then calves, then turn over to my quads. You can also do your back if you like. You want to roll back and forth for 1min, for 3x on each muscles for 2 or 3x a day. Also find your the area that the most painful and stiff and use the foam roller to apply pressure, hold it for atleast 30sec to 1min. if you cant relieved your muscle on your own, tried working with your PT, most PT are certified to do sports massage. Or you can try to find a stretch therapist but not all insurance cover it, might have to pay out of your own pocket.